CMS accepted some of our suggestions. It reduced the number of questions from 53 to 43, and it removed the question, “How often did doctors spend enough time with you?” It refused to change “emergency room” to “emergency department,” but it did change the pain questions to the following:

• “During this emergency room visit, did you have any pain?”
• “During this emergency room visit, did the doctors and nurses try to help reduce your pain?”
• “During this emergency room visit, did you get medicine for pain?”
• “Before giving you pain medicine, did the doctors and nurses describe possible side effects in a way you could understand?”

Physician leaders of ACEP have been active in the ongoing transformation of [the EDPEC] survey.

Testing and Revision

Then CMS field-tested its draft survey on a selected number of emergency departments.

In 2017, CMS convened a technical expert panel on the EDPEC survey. Thom Mayer, MD, FACEP, executive vice president of EmCare, founder and CEO of Best Practices, Inc., and clinical professor of emergency medicine at George Washington University in Washington, D.C., and I served on that panel. We had a several-hour conference call and follow-up communication. The newest draft published in August 2017 has a total of 39 questions (29 questions about the care, 10 demographic), and these are the pain questions:

• “During this emergency room visit, did you have any pain?”
• “During this emergency room visit, did the doctors or nurses talk with you about how much pain you had?”

In a later section under “Leaving the Emergency Room,” there are additional questions regarding pain:

• “Before you left the emergency room, did the doctors or nurses give you as much information as you wanted about how to treat your pain at home?”
• “Before you left the emergency room, did the doctors or nurses talk with you about things you could do at home to reduce your pain other than take medicine?”

Response options include the three “Yes, definitely; Yes, somewhat; and No” and also a fourth option, “I did not need to reduce pain after I got home from the emergency room.”

We hope that emergency physicians will view this as a major win for us. While the pain questions are not completely gone, they are much improved, and there is a question on the nonpharmaceutical treatment of pain.

CMS and the RAND EDPEC team have been working with us to make the survey appropriate and meaningful. The second round of feasibility testing for the EDPEC DTC survey is now being completed. The testing has a push-to-web focus. This round of feasibility testing is examining issues such as:

• Survey response rates and differences by survey administration arm
• Email and mobile phone coverage rates
• Feasibility of email and text invitations to a web survey
• Testing of the use of a QR code in a mailed invitation
• Paradata, such as how long the surveys (and individual items) take, what type of device individuals use to respond to web surveys, whether people are changing their answers, etc.

CMS and the RAND EDPEC team have asked us to not share the current draft of the survey, as the survey will continue to evolve in response to results from feasibility testing. They will be holding another round of technical expert panels this summer once preliminary data from the field testing are available, and we will again serve on that panel to represent the views of emergency physicians and the patients we serve.